Mental Health Policy Development Research Articles

Integration of traditional and western treatment approaches in mental health care in Pacific Island Countries.

To explore the extent of integration of traditional and western approaches in mental health care in Pacific Island Countries (PICs). Examination of national mental health policies and literature review. Traditional healers were included as resources for mental health in four of the seven policies that we were able to access. While their role in mental health care is widely acknowledged in the literature, there are few empirical studies exploring integration. Local research on integrative mental health care is needed to guide mental health policy and service development in PICs. Any research must include the full range of formal and informal service providers as well as patients and families.

Older people's mental health in rural areas: Converting policy into service development, service access and a sustainable workforce.

This paper describes the older people's mental health workforce development, policy development and implementation process and quantifies the rural service delivery and access impacts over a 15-year period in New South Wales. It highlights the factors that are considered to be critical to successful rural service development such as commitment to funding parity, investment in strong local service leadership, and development of innovative, locally adapted rural service models. Building on these foundations, the Older People's Mental Health Program in New South Wales was able to address key challenges relating to service access in rural health and develop new, sustainable specialist older people's mental health service networks. A sustained focus on policy and implementation which explicitly supports rural older people's mental health service enhancement, and development of evidence-based models of care, has significantly improved access to specialist mental health care for older people in rural areas. It has delivered 23 new rural older people's mental health community teams and a 440% increase in the number of people accessing these teams. It has also doubled the number of acute inpatient units and established new specialistmental health-residential aged care partnership services in rural New South Wales. It has resulted in increased access to services for the "older old," while not diminishing older people's rates of access to general adult mental health services. It has also supported innovative, sustainable rural service models such as "hub and spoke" models and step-up step-down inpatient services that build on existing health and hospital infrastructure and link geographically dispersed specialist clinicians and services together in rural service delivery.

Une clinique sous occupation. Entretien avec Dr. Samah Jabr

AimSamah Jabr is a Palestinian psychiatrist and psychotherapist, and the current head of the ministerial Mental Health Unit in the occupied West Bank. This article aims to make her work and the question of mental health in Palestine better known to the French-speaking readership interested in the links between psychiatry, war and colonial occupation. MethodThe present article is based on the transcript of an interview with Samah Jabr, conducted in January 2018 at the Psychology Department in Paris 13-Sorbonne Paris-Cité University. ResultsPracticing within an occupied nation requires the development of specific mental health policies and clinical tools. After an overview of her training, from Jerusalem to Bethlehem, Paris and London, this interview explores S. Jabr's institutional work, which has two broad aims: on the one hand, the development of mental health services in the Occupied Territories, and on the other, the dissemination of mental healthcare and its implantation within the Palestinian community. Throughout this interview, S. Jabr's clinical and theoretical perspectives are unfolded, with emphasis on a qualitative differentiation between demoralization, i.e. psychosocial suffering, and psychopathology. DiscussionThis interview explores the clinical and political practice of the author, whose work is in line with the legacy of Fanon. Via a holistic approach, the article broaches the subject of the treatment of adolescents following imprisonment, or of patients with reactive symptoms subsequent to torture; it also reflects on the effects of politically motivated humiliation, as well as on the difficulties of counter-transference when dealing with mechanisms of identification with the aggressor. ConclusionThe article ends with reflections on factors promoting the resilience of Palestinian society.

Ekspertiza i razvoj hrvatske politike mentalnog zdravlja: percepcija strucnjaka iz podrucja mentalnog zdravlja

Previous research shows that Croatian mental health policy is not a political priority, that it lacks interdisciplinarity, intersectoral collaboration and a holistic approach. Following the assumption that one of the main reasons for this position is the low level of knowledge in mental health policy- making, this study was set to examine the role of expertise and knowledge translation in Croatian mental health policy development. The study was conducted during spring 2018 and has included 124 participants, professionals from different institutions dealing with mental health, using the snowball method. The questionnaire “Development of Croatian Mental Health Policy” was developed for the purpose of this study. The gathered qualitative and quantitative data shows that professionals in the mental health sector describe policymaking in the field as being of poor quality and highly dependent on top governmental bodies that are run by the political elite uninterested in mental health. The data also proves that mental health professionals in Croatia think about the improvement of mental health policy in line with international guidelines. Still, they rarely consider themselves an active force in policy- making. That leads us to the conclusion that experts and professionals need support to form networks, advocacy coalitions and better inter- sectoral relationships in order to influence the political will.

Critical Evaluation of a Survey Claiming “Long-Term Adverse Outcomes from Neonatal Circumcision”*

We critically evaluate an online “Global survey of circumcision harm” that gauged beliefs of men who thought that their neonatal circumcision had harmed them. Sequential evaluation of the survey data and claims reveal numerous serious flaws that are at odds with strong scientific evidence. Moreover, the one-sided study design and “loaded” survey title meant the findings were not representative of the general population of circumcised males. None of the participants’ claimed physical problems were confirmed by a health practitioner. Belief in this seriously flawed survey has potential to cause psychological harm to vulnerable men influenced by anti-circumcision claims, and as such has serious detrimental implications for male sexual health. The survey appears driven less by empiricism and more by psychological forces, as we show in de-tail. The overwhelming body of high quality medical scientific evidence finds no adverse effect of male circumcision on sexual function and pleasure, but strong evidence for a wide array of lifetime benefits in protection against infections, dermatological problems, and genital cancers. Consistent with the United Nations Convention on the Rights of the Child, children are entitled to low risk procedures that are beneficial to their health. In conclusion, the survey and its uncritical presentation do a disservice to evidence-based medicine, sexual health, mental health, public health, human rights, and pediatric policy development. It should therefore be dismissed as unreliable.

Can automated content analysis be used to assess and improve the use of evidence in mental health policy? A systematic review

BackgroundThis review assesses the utility of applying an automated content analysis method to the field of mental health policy development. We considered the possibility of using the Wordscores algorithm to assess research and policy texts in ways that facilitate the uptake of research into mental health policy.MethodsThe PRISMA framework and the McMaster appraisal tools were used to systematically review and report on the strengths and limitations of the Wordscores algorithm. Nine electronic databases were searched for peer-reviewed journal articles published between 2003 and 2016. Inclusion criteria were (1) articles had to be published in public health, political science, social science or health services disciplines; (2) articles had to be research articles or opinion pieces that used Wordscores; and (3) articles had to discuss both strengths and limitations of using Wordscores for content analysis.ResultsThe literature search returned 118 results. Twelve articles met the inclusion criteria. These articles explored a range of policy questions and appraised different aspects of the Wordscores method.DiscussionFollowing synthesis of the material, we identified the following as potential strengths of Wordscores: (1) the Wordscores algorithm can be used at all stages of policy development; (2) it is valid and reliable; (3) it can be used to determine the alignment of health policy drafts with research evidence; (4) it enables existing policies to be revised in the light of research; and (5) it can determine whether changes in policy over time were supported by the evidence. Potential limitations identified were (1) decreased accuracy with short documents, (2) words constitute the unit of analysis and (3) expertise is needed to choose ‘reference texts’.ConclusionsAutomated content analysis may be useful in assessing and improving the use of evidence in mental health policies. Wordscores is an automated content analysis option for comparing policy and research texts that could be used by both researchers and policymakers.

Current Representation of People With Intellectual Disability in Australian Mental Health Policy: The Need for Inclusive Policy Development

AbstractPeople with intellectual disability in Australia experience poor mental health, are underrepresented in mental health policy, and encounter major barriers in accessing mental health services and treatments. This study interrogated the current representation of people with intellectual disability and recommended strategies to enhance the inclusion of intellectual disability in mental health policy. A policy analysis framework was developed that included context, stakeholders, process, and content. Nine pieces of Australian mental health legislation and 37 mental health policy documents were analyzed using the framework. Fifteen of the 37 documents included mention of intellectual disability with limited attention to the specific mental health needs of people with intellectual disability and mental illness. Only two documents identified specific strategies or measurable actions and targets to improve the access of people with intellectual disability and mental illness to mental health services. The documents’ strengths that may be applied to develop inclusive intellectual disability mental health policy included being values‐based, recognizing diversity, taking a life‐course approach, focusing on workforce development, and ensuring checks and balances. An inclusive approach to the development and implementation of intellectual disability mental health policy will best meet the mental health needs of individuals with intellectual disability. An inclusive policy approach will be based on a sound evidence‐base and include a comprehensive understanding of the context in which the policy is developed; consultation with key stakeholders including people with intellectual disability and mental illness, their family and carers, and those who work with them; cross‐sector collaboration and workforce training. An inclusive approach to the development and implementation of intellectual disability mental health policy using an integrated knowledge translation approach will address the current lack of attention to the important area of how to best meet the mental health needs of individuals with intellectual disability.

Mental health consultations in the perinatal period: a cost-analysis of Medicare services provided to women during a period of intense mental health reform in Australia.

Objective To quantify total provider fees, benefits paid by the Australian Government and out-of-pocket patients' costs of mental health Medicare Benefits Schedule (MBS) consultations provided to women in the perinatal period (pregnancy to end of the first postnatal year). Method A retrospective study of MBS utilisation and costs (in 2011-12 A$) for women giving birth between 2006 and 2010 by state, provider-type, and geographic remoteness was undertaken. Results The cost of mental health consultations during the perinatal period was A$17.5million for women giving birth in 2007, rising to A$29million in 2010. Almost 9% of women giving birth in 2007 had a mental health consultation compared with more than 14% in 2010. An increase in women accessing consultations, along with an increase in the average number of consultations received, were the main drivers of the increased cost, with costs per service remaining stable. There was a shift to non-specialist care and bulk billing rates increased from 44% to 52% over the study period. In 2010, the average total cost (provider fees) per woman accessing mental health consultations during the perinatal period was A$689, and the average cost per service was A$133. Compared with women residing in regional and remote areas, women residing in major cities where more likely to access consultations, and these were more likely to be with a psychiatrist rather than an allied health professional or general practitioner. Conclusion Increased access to mental health consultations has coincided with the introduction of recent mental health initiatives, however disparities exist based on geographic location. This detailed cost analysis identifies inequities of access to perinatal mental health services in regional and remote areas and provides important data for economic and policy analysis of future mental health initiatives. What is known about the topic? The mental healthcare landscape in Australia has changed significantly over the last decade, with the introduction of numerous policies aimed at prevention, screening and improving access to treatment. Several of these policies have been aimed at perinatal depression, which affects 15% of women giving birth. What does this paper add? This is the first population-based, cost analysis of mental health consultations during the perinatal period (pregnancy to end of the first postnatal year) in Australia. Almost 9% of women giving birth in 2007 had a mental health consultation funded though the MBS, compared with more than 14% in 2010. Over the same period there was a shift from psychiatric consultations to allied health and primary care consultations. In 2010, the total cost (provider fee) of these consultations was A$29million, equating to an average cost per woman of A$689 and A$133 per service. Despite the changing policy environment, significant disparities exist in access to care according to geographic remoteness. What are the implications for practitioners? Recent policy initiatives have resulted in increasing access to mental health consultations for women around the time of childbirth. However, policies are needed that target women outside of major cities. Furthermore, evidence is needed on whether the increase in access has resulted in improved mental health outcomes for women at this vulnerable time. The cost data provided by this study are unique and will inform future mental health policy development and health economic evaluations.

Health and wellbeing of sexual minorities

Most of the information in Chile about health and wellbeing of sexual minorities refers to risk behaviors. To assess health and wellbeing in a sample of Chilean homosexual men and women. Spanish versions of the Satisfaction With Life Scale and Outcome Questionnaire-45 (OQ-45) were answered by 191 homosexual women and 256 homosexual men aged 18 to 67 years, from four Chilean cities. Lesbian women have better levels of satisfaction with life and adjustment in personal relationships than homosexual men. Eight percent of respondents had suicidal thoughts in some moment of their life. The information gathered in this work could help in the development of mental health policies for sexual minorities.

Mental health service use and need for care of Australians without diagnoses of mental disorders: findings from a large epidemiological survey.

While epidemiological surveys worldwide have found a considerable proportion of people using mental health services not to have a diagnosis of a mental disorder, with possible implications of service overuse, other work has suggested that most people without a current diagnosis who used services exhibited other indicators of need. The aims of the present study were, using somewhat different categorisations than previous work, to investigate whether: (1) Australians without a diagnosis of a mental disorder who used mental health services had other indicators of need; and (2) how rate and frequency of service use in Australia related to level of need, then to discuss the findings in light of recent developments in Australian Mental Health Policy and other epidemiological and services research findings. Data from the Australian National Survey of Mental Health and Wellbeing (NSMHWB) 2007 was analysed. Most people using mental health services had evident indicators of need for mental health care (MHC), and most of those with lower evident levels of need did not make heavy use of services. Only a small proportion of individuals without any disorders or need indicators received MHC (4%). Although this latter group comprises a fair proportion of service users when extrapolating to the Australian population (16%), the vast majority of these individuals only sought brief primary-care or counselling treatment rather than consultations with psychiatrists. Access and frequency of MHC consultations were highest for people with diagnosed lifetime disorders, followed by people with no diagnosed disorders but other need indicators, and least for people with no identified need indicators. Limitations include some disorders not assessed in interview and constraints based on survey size to investigate subgroups defined, for instance, by socioeconomic advantage and disadvantage individually or by characteristics of area. MHC for individuals with no recognised disorders or other reasonable need for such care may be occurring but if so is likely to be an area-specific phenomenon. Rather than revealing a large national pool of treatment resources being expended on the so-called 'worried well', the findings suggested a generally appropriate dose-response relationship between need indicators and service use. Definitive ascertainment of area-specific disparities in this national pattern would require a different survey approach. Government proposals for widespread introduction of stepped-care models that may seek to divert patients from existing treatment pathways need to be implemented with care and well informed by local data.

Interdisciplinary research framework for multisectoral mental health policy development

AbstractThis paper proposes an interdisciplinary research framework for developing mental health policy in countries where a multisectoral approach to population mental health is not yet on the policy agenda. The proposed mental health policy research framework contains two structural elements: research on the policy content and policy process dimensions. The content dimension defines mental health policy as being a multisectoral policy encompassing positive mental health for all, the prevention and treatment of mental disorders, and the social and human rights consequences of poor mental health. The process dimension is based on the cyclical model of policy processes as described by Kingdon’s theory of agenda-setting and Rochefort’s analysis of the factors which affect mental health policy-making. The framework presents an innovative approach to researching mental health policy, bringing a more interdisciplinary focus and an explicit emphasis on policy-making.

The 2015 National Canadian Homeless Youth Survey: Mental Health and Addiction Findings

This study was designed to provide a representative description of the mental health of youth accessing homelessness services in Canada. It is the most extensive survey in this area to date and is intended to inform the development of mental health and addiction service and policy for this marginalized population. This study reports mental health-related data from the 2015 "Leaving Home" national youth homelessness survey, which was administered through 57 agencies serving homeless youth in 42 communities across the country. This self-reported, point-in-time survey assessed a broad range of demographic information, pre-homelessness and homelessness variables, and mental health indicators. Survey data were obtained from 1103 youth accessing Canadian homelessness services in the Nunavut territory and all Canadian provinces except for Prince Edward Island. Forty-two per cent of participants reported 1 or more suicide attempts, 85.4% fell in a high range of psychological distress, and key indicators of risk included an earlier age of the first episode of homelessness, female gender, and identifying as a sexual and/or gender minority (lesbian, gay, bisexual, transgender, queer, and 2 spirit [LGBTQ2S]). This study provides clear and compelling evidence of a need for mental health support for these youth, particularly LGBTQ2S youth and female youth. The mental health concerns observed here, however, must be considered in the light of the tremendous adversity in all social determinants faced by these youth, with population-level interventions best leveraged in prevention and rapid response.

Strengthening mental health system governance in six low- and middle-income countries in Africa and South Asia: challenges, needs and potential strategies.

Poor governance has been identified as a barrier to effective integration of mental health care in low- and middle-income countries. Governance includes providing the necessary policy and legislative framework to promote and protect the mental health of a population, as well as health system design and quality assurance to ensure optimal policy implementation. The aim of this study was to identify key governance challenges, needs and potential strategies that could facilitate adequate integration of mental health into primary health care settings in low- and middle-income countries. Key informant qualitative interviews were held with 141 participants across six countries participating in the Emerging mental health systems in low- and middle-income countries (Emerald) research program: Ethiopia, India, Nepal, Nigeria, South Africa, and Uganda. Data were transcribed (and where necessary, translated into English) and analysed thematically using framework analysis, first at the country level, then synthesized at a cross-country level. While all the countries fared well with respect to strategic vision in the form of the development of national mental health policies, key governance strategies identified to address challenges included: strengthening capacity of managers at sub-national levels to develop and implement integrated plans; strengthening key aspects of the essential health system building blocks to promote responsiveness, efficiency and effectiveness; developing workable mechanisms for inter-sectoral collaboration, as well as community and service user engagement; and developing innovative approaches to improving mental health literacy and stigma reduction. Inadequate financing emerged as the biggest challenge for good governance. In addition to the need for overall good governance of a health care system, this study identifies a number of specific strategies to improve governance for integrated mental health care in low- and middle-income countries.

Indicadores de gobernanza en políticas y programas de salud mental en México: una perspectiva de actores clave

ObjectiveTo analyse the role of Mexico's mental health system governance in the development of mental health policies and programmes, from the perspective of its own actors. MethodsA map was developed for identifying the actors in Mexico's mental health system. A guide was designed for in-depth interviews, which were recorded and arranged in categories for their analysis. The Atlas-ti v.7 software was used for the organisation of qualitative data and Policy Maker v.4 was used to determine the position and influence of actors within the health system. ResultsThe actors were identified according to their level of influence in mental health policies: high, medium and low. Actors with a high level of influence participate in national policies, actors with medium influence are involved in regional or local policies and the participation of actors with a low level of influence is considered marginal. ConclusionsThis study facilitated understanding of governance in mental health. The level of influence of the actors directly affects the scope of governance indicators. Relevant data were obtained to improve policies in mental health care.

An extended cost-effectiveness analysis of schizophrenia treatment in India under universal public finance.

BackgroundSchizophrenia remains a priority condition in mental health policy and service development because of its early onset, severity and consequences for affected individuals and households.Aims and methodsThis paper reports on an ‘extended’ cost-effectiveness analysis (ECEA) for schizophrenia treatment in India, which seeks to evaluate through a modeling approach not only the costs and health effects of intervention but also the consequences of a policy of universal public finance (UPF) on health and financial outcomes across income quintiles.ResultsUsing plausible values for input parameters, we conclude that health gains from UPF are concentrated among the poorest, whereas the non-health gains in the form of out-of-pocket private expenditures averted due to UPF are concentrated among the richest income quintiles. Value of insurance is the highest for the poorest quintile and declines with income.ConclusionsUniversal public finance can play a crucial role in ameliorating the adverse economic and social consequences of schizophrenia and its treatment in resource-constrained settings where health insurance coverage is generally poor. This paper shows the potential distributional and financial risk protection effects of treating schizophrenia.Electronic supplementary materialThe online version of this article (doi:10.1186/s12962-016-0058-z) contains supplementary material, which is available to authorized users.

The Development of Mental Health Policies in the Czech Republic and Slovak Republic since 1989

Abstract The article aims to describe the key events in the development of mental health care policies after 1990 in the two countries and identify the main reasons for stagnation or incremental changes to the institutional setting in the field of mental health care. The process of mental health care reform is explained using the framework of historical institutionalism. The explanation shows that the lack of political interest in combination with the tradition of institutional care resulted in poor availability of psychiatric care, outdated network of inpatient facilities and critical lack of community care facilities in both countries. Even though Slovak Republic adopted national programme at the governmental level, it still struggles with its implementation. The ongoing reform attempt in the Czech Republic may bring some change, thanks to a new approach towards strategic governance of the mental health care system and the mechanism of layering that the promoters of the reform use.

Value-based mental healthcare: The quality aspect

IntroductionThe goal of value-based healthcare is to improve the quality of care while also lowering healthcare costs. Values may also include societal or research benefits.ObjectivesTo outline the emergence and quality-related concepts of value-based healthcare.AimsTo give a comprehensive overview and critical discussion of quality aspects of value-based mental healthcare including aspects of personal, societal and scientific values.MethodsReview of quality aspects of value-based mental healthcare.ResultsThe quality aspect of value-based healthcare includes the implementation of patient-centered care and may include the assessment of societal values or values for research purposes. Current concepts focus on the reduction of disability-adjusted life years to measure the achievement of values, but may need to be broadened to include benefits to society as a whole or the progress of knowledge about mental disorders in research. Conceptually, addressing such broader value issues may lead to increased benefits and a better appraisal of the value of mental healthcare.ConclusionsThe trend towards value-based mental healthcare aims at creating an efficient care delivery model, that strongly focuses on achieving favorable patient outcomes and may in the future also include creating societal values. It includes the development and implementation of suitable mental health policies and comprehensive quality assessment, plus a broad conceptualization of the value-term and its assessment in value-based mental healthcare.Disclosure of interestThe author has not supplied his declaration of competing interest.

Review of the Challenges Facing Management of Patients with Psychotic Disorder and the Need for Mental Health Policies in Nigeria

ABSTRACT Psychosis is a chronic recurrent neuropsychiatric disorder that impairs the quality of life of the individuals and represents a major public health issue. Poverty, unemployment, family instability, substance misuse and obstetric complications are the major risk factors for the rising cases of psychotic illnesses in Nigeria. However, the traditional African people still believe that the disease is due to supernatural forces at work against the mental wellbeing of the individuals and as such cure cannot be found through modern medicines. Thus, the management of the illness is mostly carried out in traditional healing centers and prayer houses without any proper regard for the human rights of the patients. The absence of comprehensive mental healthcare policy also contributes to the maltreatments and sufferings of these patients in Nigeria. Thus, this mini-review highlights the challenges facing the management of patients with psychotic disorder in Nigeria and the need for the development of comprehensive mental health policies that will specifically address these issues. Mini-review Article

Mental health law in Colombia.

Mental health law in Colombia has evolved over the past 50 years, in concert with worldwide recognition and prioritisation of mental healthcare. Laws and policies have become increasingly sophisticated to accommodate the ongoing transformations throughout Colombia's healthcare system and improvements in mental health screening, treatment and supportive care. Mental health law and policy development have been informed by epidemiological data on patterns of mental disorders in Colombia. Colombia is distinguished by the fact that its mental health laws and policies have been formulated during a 60-year period of continuous armed conflict. The mental health of Colombian citizens has been affected by population-wide exposure to violence and, accordingly, the mental health laws that have been enacted reflect this feature of the Colombian experience.

I am the person of whom you speak

As consumers/survivors increasingly take up roles of influence within mental health service delivery and policy development, tensions sometimes arise about the validity and relevance of consumer perspectives. The author proposes that these tensions may be indicative of failure by the mental health system and the broader community to communicate, understand and believe in personal recovery. This first-person account reflects, in both poetry and prose, about the personal impacts of having the validity and relevance of one’s own experience denied, along with a personal account of the experience of madness and trauma, pessimistic prognosis, involuntary treatment, hope and personal recovery.